In one paragraph
Texas HB 4018 (2025), as introduced, would have added Insurance Code Sec. 4201.156, requiring a utilization review agent that uses an AI-based algorithm or other software tool to ensure it bases determinations on the enrollee's clinical history and circumstances, does not override a physician or provider, and does not discriminate. The agent could not use AI as the sole basis to deny, delay or modify health care services. It died when the regular session adjourned June 2, 2025.
Plain-English summary, written with AI assistance. The official text controls.
What it means for business
No duties for businesses because the bill died. Had it passed, utilization review agents using AI tools would have had to keep clinicians in control, disclose oversight procedures and allow inspection of the tool.
Key provisions
- Determinations must rest on the enrollee's medical or other clinical history, individual clinical circumstances presented by the provider of record, and other relevant clinical information, not solely on a group dataset
- The algorithm or tool may not override the decision making of a physician or health care provider and may not discriminate directly or indirectly against enrollees
- It must be available for review and inspection under Sec. 4201.154, and its use and oversight procedures disclosed in writing to enrollees
- Performance, use and outcomes must be periodically reviewed and revised to maximize accuracy and reliability; patient information may not be used beyond its stated purpose
- May not use AI as the sole basis to wholly or partly deny, delay or modify health care services; only a physician or licensed provider may determine medical necessity
- No penalty is stated; text takes effect September 1, 2025; the bill died at sine die adjournment
Latest legislative action
Mar 27, 2025. Referred to Insurance; died when the 89th Legislature's regular session adjourned June 2, 2025
Sponsors (showing 5 of 17)
| Name | Role |
|---|---|
| Ashby | Primary |
| Capriglione | Primary |
| Frank | Primary |
| Garcia | Primary |
| Guillen | Primary |
Topics and industries
Affected industries
This page is general information, not legal advice. Summaries are AI-assisted and may contain errors; read the statute for the controlling text and talk to a lawyer about your situation. Full disclaimer · Report an error